- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $1,223.00 / $2,250.00
| Facility | | $750.00 | $1,223.00 | $2,250.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $469.03 / $469.03 / $469.03
| Facility | 52 | $469.03 | $469.03 | $469.03 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $703.55 / $703.55 / $703.55
| Facility | 54 | $703.55 | $703.55 | $703.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,317.51 / $1,594.95 / $2,145.71
| Facility | | $1,317.51 | $1,594.95 | $2,145.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $1,768.00 / $3,360.00
| Facility | | $625.00 | $1,768.00 | $3,360.00 |